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Comparision of two techniques for the placement of a feeding tube to the stomach through the skin in an individual who has difficulty swallowing food

Review question

This systematic review was conducted to compare two different methods for placing a feeding tube to the stomach via an opening in the skin (known as percutaneous gastrostomy) in order to provide food to an individual with swallowing difficulties; the aim was to find the most effective and safe approach.

Background

Placing a feeding (gastric) tube to the stomach percutaneously (through an opening in the skin) is a less-invasive method than open surgery. Percutaneous gastrostomy can be guided either using an optical instrument (or endoscope) that can be used to look inside the body (termed percutaneous endoscopic gastrostomy or PEG) or using guidance from external techniques that are used to obtain an image of the inside of the body (known as percutaneous radiological gastrostomy or PRG). Both PEG and PRG are associated with high rates of success in the placement of gastric tubes, but which is the best method has yet to be determined.

Study characteristics

We searched a number of online resources to identify studies that compared PEG and PRG in individuals with swallowing disturbances in a randomised controlled manner. This type of study is the best research method for identifying any differences between two techniques used for the same procedure.

Key results

We identified no randomised controlled studies comparing PEG and PRG in individuals with swallowing disturbances. Because of this lack of evidence, we are therefore not currently able to determine which technique is superior to the other for the placement of a gastric tube, and can make no definitive recommendations. Randomised controlled trials are required in order to determine the optimal method for percutaneous gastrostomy in individuals with swallowing difficulties.

Authors' conclusions:

Both PEG and PRG are effective for long-term enteral nutritional support in selected individuals, though current evidence is insufficient to recommend one technique over the other. Choice of technique should be based on indications and contraindications, operator experience and the facilities available. Large-scale RCTs are required to compare the two techniques and to determine the optimal approach for percutaneous gastrostomy.

Read the full abstract...

Background:

Gastrostomy has been established as the standard procedure for administering long-term enteral nutrition in individuals with swallowing disturbances. Percutaneous gastrostomy is a less-invasive approach than open surgical gastrostomy, and can be accomplished via endoscopy (percutaneous endoscopic gastrostomy or PEG) or sonographic or fluoroscopic guidance (percutaneous radiological gastrostomy or PRG). Both techniques have different limitations, advantages, and contraindications. In order to determine the optimal technique for long-term nutritional supplementation many studies have been conducted to compare the outcomes of these two techniques; however, it remains unclear as to which method is superior to the other with respect to both efficacy and safety.

Objectives:

To compare the safety and efficacy of PEG and PRG in the treatment of individuals with swallowing disturbances.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, January 2016); MEDLINE (1946 to 22 January 2016); EMBASE (1980 to 22 January 2016); the reference lists of identified articles; databases of ongoing trials, including the Chinese Cochrane Centre Controlled Trials Register; and PubMed. We applied no language restrictions.

Two authors independently evaluated the search results and assessed the quality of the studies. Data analyses could not be performed as no RCTs were identified for inclusion in this review.

Main results:

We identified no RCTs comparing PEG and PRG for percutaneous gastrostomy in individuals with swallowing disturbances. The large body of evidence in this field comes from retrospective and non-randomised controlled studies and case series. Based on this evidence, both PEG and PRG can be safely performed in selected individuals, although both are associated with major and minor complications. A definitive RCT has yet to be conducted to identify the preferred percutaneous gastrostomy technique.